Senior Citizen Waiver Form                                                                                                                             Revised June 10, 2020 
 
               
 
 
 
 
Senior Citizen Education Tuition Program Fee Waiver Form 
 
Proof of Status: To be eligible for waiver of tuition and fees, person seeking the Senior Citizen Education 
Program must meet the following criteria: Be at least 60 years of age, must show senior citizen ID card 
issued by the Unites Stated Virgin Islands Department of Human Services, and be a resident of the United 
States Virgin Islands for at least one year. (Undergraduate Catalog 2014-2015, pp. 27-28). 
 
SEMESTER (indicate one)  
 
Fall 
   Spring  
  Summer Session(s) 
 I or II      Year__________ 
 
 
Name of Student: ________________________________________ Student ID Number:  _____________ 
Mailing Address: _______________________________________________________________________ 
City: _____________________________________________ State and Zip: ________________________   
           
      
 
Requested Courses  
 
 
 
 
Pre-requisites* 
1. _________________________________  
 
______________________________ 
2. _________________________________  
 
______________________________ 
3. _________________________________  
 
______________________________ 
4. _________________________________  
 
______________________________ 
5. _________________________________  
 
______________________________ 
6. _________________________________  
 
______________________________ 
*Pre-Requisites may be required for courses. 
 
 
Student Signature:  
_______________________________________________ Date:  _____________ 
 
 
Registrar Office Signature: ___________________________________________ Date:  _____________ 
 
 
For Business Office Use Only:  Total Credits:  ______________ Tuition Amount: _________________ 
 
 
For Registrar’s Office Use Only: 
Senior Citizen Card ID#_____________________________   Expiration Date: ____________________ 
Proof of Age: □ yes         □ No 
Degree Student: □ yes         □ No 
Proof of Residence: □ yes         □ No 
  Non-Degree Student: □ yes         □ No 
Credit Total:  
Audit: □ yes         □ No 
Access and Enrollment Services 
SIGN
SIGN